Antimicrobial susceptibility of nontyphoidal Salmonella isolated from humans in Belgium.

Human nontyphoidal Salmonella infections are the primary cause of foodborne disease in developed countries, resulting in considerable morbidity and occasionally death, especially in immunocompromised patients. Strains of Salmonella that are resistant to antimicrobial agents have become a world-wide health problem. Fluoroquinolones are drugs of choice for treatment of human invasive salmonellosis, and have been useful for the treatment of infections caused by multi-resistant strains. However, strains resistant to ciprofloxacin have been noted. A random sample of 378 Salmonella strains of human origin was collected during 1998. Their susceptibility to 11 antimicrobial agents was determined by the agar dilution method according to NCCLS standards. In total, 38 serotypes were represented of which S. Enteritidis (20.4%), S. Typhimurium (20.4%), S. Hadar (9.0%), S. Brandenburg (7.9%), S. Infantis (7.7%), and S. Virchow (5.3%) were the most common. All strains were susceptible to ceftriaxone and ciprofloxacin. For nalidixic acid the rate of resistance was 19.0%. Of the 72 strains resistant to nalidixic acid, 31 were S. Hadar, and thus 91.2% (31/34) of the S. Hadar isolates showed resistance to nalidixic acid. Most of the S. Hadar strains were also resistant to ampicillin, tetracycline and sulphamethoxazole, and an elevated MIC50 (0.25 microgram/ml) and MIC90 (1 microgram/ml) was observed for ciprofloxacin. The high rate of resistance to nalidixic acid can be a first step towards the development of resistance to ciprofloxacin.

PCR typing of tetracycline resistance determinants (Tet A-E) in Salmonella enterica serotype Hadar and in the microbial community of activated sludges from hospital and urban wastewater treatment facilities in Belgium.

The distribution of tetracycline resistance determinants Tet A-E was studied by PCR in 40 tetracycline-resistant Salmonella enterica serotype Hadar (S. hadar) isolates collected from human patients in 1996 and 1997, as well as in the microbial community originating from activated sludges of hospital and urban wastewater treatment facilities. A fast DNA extraction and purification method from activated sludges was used to provide amplifiable DNA. The method is based on the direct lysis of bacteria improved by bead-beating followed by DNA purification on polyvinylpolypyrrolidone spin columns to remove PCR inhibitors. The purified DNAs from salmonellae and activated sludges were characterized for the presence of tetracycline determinants with specific primer pairs designed on the basis of published sequences. The Tet A determinant was present in all clinical isolates and DNAs extracted from the bacterial community of the selected activated sludges. The Tet C determinant was identified in only one of the 40 clinical isolates and in six of the seven environmental samples. No signal was detected for Tet B, D and E determinants. This study revealed a high and stable prevalence of the Tet A determinant in both salmonellae clinical isolates and the microbial community of activated sludges from hospital and urban wastewater treatment facilities over a 2-year period.

Peroneus quartus muscle: a case report and review of the literature.

The peroneus quartus is a supernumerary muscle of the lateral compartment of the lower leg. There are several variations of this accessory muscle, and its terminology is very confusing. The peroneus quartus is found with a frequency varying from 10 to 21.7% of observed individuals. It is rarely involved in pathologic processes of the foot and ankle. Only a few reports exist in the literature involving peroneus quartus in a "retromalleolar conflict" (lateral ankle stenosis), sometimes in association with longitudinal attrition and tears of the peroneus brevis. We present a novel case, together with a review of the clinical, anatomic, and radiologic references about this muscle, and we try to make order in classification and terminology of its different forms.

[Pathologic fracture of the tibia associated with Charcot-Marie-Tooth disease]. / Fracture pathologique du tibia compliquant une maladie de Charcot-Marie-Tooth.

The authors report a case of pathologic fracture of the distal tibia associated with Charcot-Marie-Tooth disease. Pathologic fracture was visible four weeks after initial pain. Treatment consisted in a short leg walking cast for six weeks. Charcot-Marie-Tooth disease is a slowly progressive neurogenic muscular atrophy affecting the distal parts of the lower limbs. The muscular atrophy is responsible for radiographic bony changes including narrowing of the shaft with thinning of the cortex, rarefaction at the end of the long bones and relative widening of the medullary cavity. Pathologic fractures in neuromuscular disease are rare; a few cases have been reported following application of very small forces. The authors draw attention to the increased risk of pathologic fractures in patients with neuromuscular disease. Ambulatory treatment of fractures should be used whenever possible; prolonged immobilization could result in further loss of function.

Palmar metacarpophalangeal joint dislocation.

Palmar dislocations of the long finger metacarpophalangeal joint are extremely rare and easily missed at the first clinical examination. We describe a palmar metacarpophalangeal dislocation of the long finger following a hyperflexion injury. The presentation, aetiology and treatment are discussed.

[Dissection of the sub-astragalar ligaments and magnetic resonance imaging]. / Les ligaments de la sous-astragalienne dissection et imagerie par résonance magnétique.

The aim of this study is to find the different ligamentous structures in the subtalar region through dissection and to compare them with images obtained on MRI. MRI allows visualization of the different ligamentous structures with greater precision than with computerized tomography. This investigation should permit a more precise diagnosis of injuries often poorly understood in this region.

[Electronic podometry--2-year experience: preliminary report]. / Podométrie électronique--deux années d'expérience: rapport préliminaire.

The authors relate their experience with the EMED system for the dynamic assessment of plantar pressure used in clinical practice for 2 years: how the measurement device was chosen; how the examination is performed; the usefulness of this type of examination in foot surgery. They discuss the specific problems related to the application of this new diagnostic tool in clinical practice.

Urine excretion of methoxy-hydroxyphenylglycol: a method of measure.

A very good correlation is found between 24 hs urine excretion of MHPG and a single early morning sample. This last method appears to be sufficient for clinical purpose and much easier and safer.

Study of the diagnostic value of the dexamethasone suppression test in endogenous depression.

The diagnostic value of the dexamethasone suppression test (DST) in "endogenous" depression was evaluated in 209 psychiatric inpatients. A high incidence of abnormal DST results was observed in "endogenous" depressives (52%), schizo-affective (69%) and borderline patients (38%). However, 25% of the patients with other psychiatric disease also failed to suppress on the DST. Diagnostic criteria, previous history of alcoholism, psychiatric drug treatment, age and sex did not significantly affect DST performance. The present data do not indicate that the DST represents a highly specific marker of "endogenous" depression.

[Characterization of antibiotic resistance plasmids in 2 strains of Salmonella typhi isolated in Belgium]. / Caractérisation des plasmides de résistance aux antibiotiques chez deux Salmonella typhi isolées en Belgique.

Two strains of Salmonella typhi resistant to streptomycin, tetracycline, chloramphenicol and sulfonamides were studied. Conjugation and analysis of plasmid DNA suggested that in the two strains, these resistance characters were mediated by a single R plasmid. The plasmids of both strains belonged to the FI-incompatibility group, whereas that isolated from the resistant Mexican S. typhi belonged to incomtibility group H. Therefore, the two resistant S. typhi isolated in Belgium do not represent an extension of the H plasmid which was responsible for chloramphenicol resistance in S. typhi during the 1972 Mexican epidemic.

[Biomechanical study of the ankle joint]. / Contribution à létude biomécanique de la pince malléolaire.

The authors have studied the transmission of body weight in several positions. Two methods have been used - strain gauges and injection of dye into the joint capsules to show areas with contact during weight-bearing and non weight-bearing. The findings have shown the role of the fibula and of both malleoli during weight-bearing which causes a noticeable increase in the area of surface contact. The lateral aspect of the talus and the medial aspect of the lateral malleolus are always in contact in any position of the talus. The fundamental role of the tibio-fibular ligaments in the mechanics of the ankle is demonstrated.